title: Everolimus-eluting stent versus bare metal stent in proximal left anterior descending ST-elevation myocardial infarction: insights from the EXAMINATION trial.
abstract: BACKGROUND
  ST-elevation myocardial infarctions (STEMI) caused by proximal left-anterior descending (LAD) lesions have more myocardium at risk and worse outcomes than those located in other segments. The aim is to compare outcomes of patients with STEMI and proximal-LAD lesions treated with bare-metal stents (BMS) versus everolimus-eluting stents (EES).
  
  
  METHODS
  The EXAMINATION trial randomized 1498 STEMI patients to BMS versus EES. The primary end point was the patient-oriented combined of all-cause death, any-recurrent myocardial infarction (MI) and any-revascularization. The secondary end point included the device-oriented combined of cardiac death, target-vessel MI and target-lesion revascularization (TLR).
  
  
  RESULTS
  STEMI with a proximal-LAD occlusion was observed in 290 patients (BMS = 132 and EES = 158). Both groups were similar except for diabetes (12.9% vs 24.1%; P = .016). At 1 year, the primary end point was observed in 18.9% and 9.5% of patients treated with BMS and EES, respectively (P = .023). The secondary end point was observed in 11.4% and 5.1%, respectively (P = .053). There were no differences in cardiac death (4.5% vs 3.8%; P = .750) and MI (1.5% vs 0%; P = .121). BMS had higher rate of TLR compared to EES (6.8% vs 1.3%; P = .014). Patients with proximal-LAD STEMI had higher mortality than patients with non proximal-LAD STEMI (5.5% vs 2.9%; P = .027). Proximal-LAD lesions treated with BMS tended to increase the risk of the primary end point compared with other segments (18.9% vs 13.0%; P = .079). However, EES implanted in proximal-LAD had similar outcomes compared with other locations (9.5% vs 12.0%; P = .430). Adjusting for confounders, the interaction between BMS and proximal-LAD location was associated with the primary end point.
  
  
  CONCLUSIONS
  Patients with STEMI and proximal-LAD lesions treated with EES have better outcomes compared with BMS at 1 year. Although further investigations are required, it seems reasonable to consider EES for proximal-LAD STEMI-lesions.
authors.affiliation: Heart Institute, University Hospital of Bellvitge, Barcelona, Spain. gomezjosep@hotmail.com
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Joan-Antoni
authors.initials: JA
authors.lastname: Gomez-Hospital
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Ferreiro
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Victoria
authors.initials: V
authors.lastname: Martin-Yuste
authors.forename: Monica
authors.initials: M
authors.lastname: Masotti
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez-Antolin
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
authors.forename: Pieter
authors.initials: P
authors.lastname: den Heijer
authors.forename: Armando
authors.initials: A
authors.lastname: Bethencourt
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vazquez
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.forename: Manel
authors.initials: M
authors.lastname: Sabate
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus